Amelia had her keyhole heart surgery when she was 9 years old. This was her third heart surgery. She started having sharp pain in her heart when she was 8 years old. She said she felt like a bubble pop inside her heart and it was painful for just split seconds.
A parent from a facebook group who has a girl with similar symptom mentioned her girl complaint of the same when she was 7 years old and it was her valve was leaking more and she has had valve replacement within 6 months.
Mummy made contact with the GOSH to ask for advice about Amelia’s chest pain by letter and telephone.
Frequency of chest pain
For monitoring purposes, mummy took note of the frequency of Amelia’s chest pain episodes.
Before 06 June 2014 – 3 – 4 times on different days
06 June 2014 once on the day
07 June 2014 twice on the day
08 June 2014 once on the day
11 June 2014 Once on the day
27 June 2014 Once on the day
19 November 2014 Once on the day
29 November 2014 Once on the day
10 December 2014 Once on the day
29 January 2015 3 times on the day
Sharp pain like a knife stab in her heart
On 19 November 2014, Amelia complaint of a sharp pain like a knife stab in her heart when she breathes in. She screamed for mummy for help at 5 am. The pain was more severe than her previous chest pain episodes. She was scared to breathe because of the extreme pain and she felt her head was heavy. The symptom comes and goes. Mummy made contact with the NHS helpline and the GOSH Cardiology clinic. The Cardiologist secretary suggested taking Amelia to see her doctor as soon as possible.
Amelia described her pain to her GP doctor and her GP suggested amelia to describe the same to her Cardiologist next Monday. Amelia is articulate and fluent in English. In the meantime, her GP doctor will also contact GOSH.
Irregular heartbeat causing sharp pain
Amelia has an irregular heartbeat. Her GP doctor said the sharp pain could be caused by an extra heartbeat or something else. He further explained irregular heartbeat could be either missing a heartbeat or having an extra heartbeat. Missing a heartbeat is not a problem but having an extra heartbeat could be a problem.
On 24 November 2014, Amelia attended a GOSH appointment. Her Cardiologists said Amelia’s heart development is interesting. Her ECG reading shown bigeminy since her second surgery and the cardiologists always considered that Amelia is asymptomatic but she does describe episodes when she gets chest pains and looks down into her precordial area and sees her heart beating fast. During her exercise test, she deteriorated from bigeminy into a short run of unimorphic VT. They are not sure her chest pains are real tachycardias but in the context of the exercise test, they should attempt to treat for her ventricular ectopic beats.
She can continue with sports activities but she must stop exercising if she has chest pain or out of breathing or feel dizzy.
Beta-blocker medication
Amelia was prescribed with a medication called beta-blockers for her abnormal heart rhythm today. Amelia is to take beta-blockers twice a day between 10 to 12 hours apart, one in the morning and another at night. The pharmacist said each intake is effective for about 8 hours.
Beta-blockers comes in liquid form and tablet. Amelia is taking the tablets and she was excited when the pharmacist showed her how to cut the beta-blockers tablet into half using a tablet cutter. This was a novelty to her. She asked mum to let her manage her medication.
Further 24 hours ECG will be arranged for Amelia to assess whether beta-blockers are effective. If it is, then Amelia will continue with the medication.
Intensive heart assessment
Subsequently, GOSH arranged a full day assessments on 06 August 2014 and this includes:
- metabolic exercise test (cycle),
- MRI, ECHO (heart scan)
- Echo
- 24 hours ECG (heart rhythm reading).
The procedures were scheduled back to back and all to be completed within one day. The first procedure starts at 9 am and the hospital staff advised to be there around 8 am.
Exercise test
Amelia was asked to paddle an exercise bike until she cannot paddle any more to analyse heart performance. Amelia’s heart shows three continuous irregular heartbeat pattern. The test was stopped there as it was not advisable to continue without cardiologist supervision.
MRI Scan
Amelia was sent to the MRI department after the exercise test. The MRI scan was performed without anaesthetic. The MRI machine was modified to cater for children. Amelia can watch a kids movie while inside the scan tunnel to keep her entertained. However, she must pay attention to the Cardiologists instructions while scanning in progress. For example, they would give out instructions like take a deep breath, hold it and breathe out slowly etc. The instructions will overwrite the movie in progress. The whole process was relatively relaxing and easy for Amelia.
Echo
After the MRI scan, Amelia was sent to have an Echo procedure. The staff scanned Amelia’s heart using a stick to move around her chest and took a couple of echo diagrams and pictures of her heart.
24 Hours ECG
This was the quick fix of a portable ECG machine on Amelia with 5 electrodes stickers on her body. Amelia can remove the stickers and ECG machine after 24 hours and sent the gadget back to the hospital.
Amelia’s results from all these tests will be discussed among cardiologists and decide what is the next treatment for Amelia.
Electrophysiological (EP) test – a keyhole heart surgery
If the ECG results shows no improvement to her irregular heartbeats then the Cardiologists will consider performing Electrophysiological (EP) test to find out what part of her heart is causing the change in rhythm. This procedure is similar to catheterisation where a tiny camera tube is inserted through the skin into a blood vessel in her groin or neck or arm.
If the EP procedure can fix the abnormal heart rhythm, Amelia would not be required to continue with the beta-blockers medication.
The MRI Scan result showed Amelia’s leaking valve development is as expected. Open heart surgery is required to fix the valve in the future but can wait 3-4 years later.
Amelia’s 12-month routine heart review is shortened to every 6 months. No definite dates for appointments of the above procedures yet.
Keyhole heart surgery day
GOSH performed a keyhole heart surgery on Amelia to fix her irregular heartbeat on 29 October 2015. The surgery took about 5 hours.
Amelia stayed overnight at the hospital after her surgery. She was discharged from the hospital the next day. The surgery was a success. In other words, her irregular heartbeat was reduced to 1%.
Amelia’s heart rate was 44bpm before the surgery. After the surgery, her heartbeat stabilises at 86bpm. Thereafter, Amelia never had a further chest pain episode again.
Big thank you to Great Ormond Street Hospital for saving Amelia’s life again.
